The spinal accessory and the phrenic nerves
were sacrificed during the operation due to the tumor's invaginating these nerves.
In our patient, the tumor was attached to the supraclavicular fossa and adherent to the scalene muscles, expanding nearby to involve vital anatomic structures, such as the internal jugular vein and accessory and phrenic nerves
. Nonetheless, the tumor could be excised en bloc and all vital structures were preserved.
You can't stop hiccupping Uncontrollable hiccups lasting hours or days are very rare, and are usually caused by irritation of the phrenic nerves
that move your diaphragm up and down as you breathe.
Irritation of phrenic nerves
, which innervates the diaphragm, can be the cause of persistent hiccups in these patients.
The phrenic nerves
(C3/4/5) supply motor function to the hemidiaphragms.
It contains the heart enclosed in the pericardium, the ascending aorta, the lower half of the superior vena cava with the azygos vein opening into it, the bifurcation of the trachea and the two bronchi, the pulmonary artery dividing into its two branches, the right and left pulmonary veins, the phrenic nerves
, and some bronchial lymph glands.
The Phrenic Nerves
. The phrenic nerves
lie along the lateral mediastinum and run from the thoracic inlet to the diaphragm (Figure 12).
(2000) Assessment of neonatal diaphragm function using magnetic stimulation of the phrenic nerves
. American Journal of Respiratory and Critical Care 162(6), 2337-2340.
If the phrenic nerves
(C3--5), which supply the diaphragm, are blocked, the patient will initially only be able to whisper and will then stop breathing.
The hiccup center may be activated by a great variety of stimuli travelling along different nerve pathways and a reflex arc has been proposed, with the phrenic nerves
, vagi, and T6-12 sympathetic fibers as the afferent limb.
Both pleural spaces were entered to optimize the visualization of the right and left phrenic nerves
. To prevent damage to phrenic nerves
, the entire anterior pericardium was decorticated within 2-3 cm of the phrenic nerves
, and then completed the dissection of the pericardium from the diaphragm.
Diaphragmatic pacing is accomplished with a series of electrodes connected to the phrenic nerves
on the diaphragm.